Publications by authors named "Scott Paxton"
Article Synopsis
- The DASH and QuickDASH questionnaires are commonly used tools to assess upper-extremity disabilities but lacked rigorous validation for patients undergoing total shoulder arthroplasty (aTSA) for advanced glenohumeral osteoarthritis (GHOA).
- In a study involving 450 patients, researchers evaluated these questionnaires alongside other measures like the ASES score to determine their effectiveness over time, looking at criteria such as validity, reliability, and patient responsiveness.
- Results showed strong correlations between the DASH/QuickDASH and other assessment scores, confirming their reliability and consistency as valid measures for evaluating outcomes in patients after aTSA procedure.
Social and demographic health disparities in shoulder and elbow surgery.
J Shoulder Elbow Surg
January 2025
Article Synopsis
- Racial and ethnic health disparities significantly affect outcomes in orthopedic shoulder surgeries, influenced by socioeconomic factors like insurance status, ethnicity, and race.* -
- A literature review identified 22 studies revealing disparities in access to care and outcomes in shoulder and elbow surgeries related to race, ethnicity, and social determinants of health.* -
- To address these disparities, recommendations include enhancing access to high-quality care by focusing on high-volume outpatient centers and improving geographical reach for surgical and rehab services.*
Article Synopsis
- A 58-year-old active man suffered tears in both teres major tendons while wakeboarding, requiring staged surgical repair.
- After following a rehabilitation protocol, he returned to high-level activities within 7 months and showed great improvement in shoulder function at the 1-year follow-up.
- The case highlights that, despite support for non-surgical treatment, surgical intervention can lead to excellent outcomes for dedicated, active individuals with acute TM tears.
Article Synopsis
- * Out of 15,445 fractures, 126 studies used PROMs, with the Constant Score being the most frequently reported, and a notable increase in PROM usage over time was observed.
- * Findings highlighted inconsistencies in outcome reporting, suggesting a need for standardization of measures to enhance comparability across studies in fracture literature.
Optimizing Visualization in Shoulder Arthroscopy: An Evidence-Based Guide.
J Am Acad Orthop Surg
November 2024
Article Synopsis
- Advances in arthroscopy have enhanced our understanding and treatment of various shoulder issues, making it a popular choice for both patients and surgeons.
- However, the surgery can be challenging due to limited visibility during the procedure.
- Techniques to improve visualization include better positioning, mechanical tools, and specific medications, but it's crucial to understand the evidence backing these methods for effective clinical application.
Background: In the continually aging United States population, the number of patients with sarcopenia who undergo shoulder arthroplasty may concomitantly increase. This retrospective cohort study aims to evaluate the rates of short-term implant-related and medical complications following shoulder arthroplasty in patients with and without a recent diagnosis of sarcopenia.
Methods: An exact 1:3 matched analysis of 4177 patients was performed using the PearlDiver database.
Article Synopsis
- - A 71-year-old woman developed post-traumatic arthritis after surgery for a shoulder fracture and later required a revision surgery to reverse total shoulder arthroplasty.
- - Following the rTSA, it was discovered that her left arm had lost blood flow due to an acute-on-chronic clot in the axillary artery, necessitating an emergency procedure to restore circulation.
- - With the growing use of rTSA for shoulder fractures, there's a potential increase in vascular injuries, highlighting the need for careful screening and monitoring for symptoms in patients at higher risk.
Background: Cervical spine degenerative disease (CSD) can cause shoulder pain, potentially confounding the management of patients with rotator cuff tears. This study aimed to investigate the relationships between CSD and rotator cuff repair (RCR).
Methods: A national administrative database (PearlDiver) was used to study 4 patient cohorts: (1) RCR only (RCRo), (2) RCR with concurrent CSD (RCRC), (3) RCR after a cervical spine procedure (RCRA), and (4) RCR before a cervical spine procedure (RCRB).
Failure of humeral shaft fixation: construct characteristics.
Eur J Orthop Surg Traumatol
December 2023
Purpose: Fixation failure following open reduction and internal fixation (ORIF) of humeral shaft fractures can be a challenging complication. We aimed to identify the modes of failure and characteristics of failed fixation constructs.
Methods: We queried our institutional database for patients > 18 years old with fixation failure after ORIF with single plate and screw constructs of humeral shaft fractures from 2006 to 2017.
Article Synopsis
- The study investigates the outcomes of two shoulder surgery options, anatomic total shoulder arthroplasty (aTSA) and ream and run (RnR), in younger patients with advanced shoulder arthritis.
- After analyzing 110 aTSA and 57 RnR patients, the results indicated that while aTSA patients had better shoulder function scores shortly after surgery, over a longer follow-up, the differences in outcomes between the two groups diminished.
- There were revision surgeries due to complications in both groups, with three RnR patients needing a revision due to pain and two aTSA patients experiencing glenoid loosening after many years.
Introduction: As rates of anatomic and reverse total shoulder arthroplasty (SA) continue to grow, an increase in the number of osteoporotic patients undergoing SA, including those who have sustained prior fragility fractures, is expected. The purpose of this study was to examine short-term, implant-related complication rates and secondary fragility fractures after SA in patients with and without a history of fragility fractures.
Methods: A propensity score-matched retrospective cohort study was done using the PearlDiver database to characterize the effect of antecedent fragility fractures in short-term complications after SA.
Article Synopsis
- This study examines the early outcomes of using intramedullary nailing (IMN) for treating displaced 2-part surgical neck fractures of the humerus, comparing it to other surgical options.
- A total of 23 patients were analyzed over a follow-up period averaging 2.5 years, with active range of motion and various shoulder-specific scores being evaluated.
- Results showed a majority of patients had satisfactory reduction and high functional outcomes, although there were some complications, including a small percentage requiring reoperation.
»: Glenoid component positioning affects implant survival after total shoulder arthroplasty, and accurate glenoid-component positioning is an important technical aspect.
»: The use of virtual planning and patient-specific instrumentation has been shown to produce reliable implant placement in the laboratory and in some clinical studies.
»: Currently available preoperative planning software programs employ different techniques to generate 3-dimensional models and produce anatomic measurements potentially affecting clinical decisions.
Introduction: Long-term outcomes of anatomic total shoulder arthroplasty (aTSA) can be compromised by glenoid loosening and failure. The purpose of this study was to evaluate the short- and midterm outcomes of humeral head replacement with glenoid reaming arthroplasty (Ream and Run) for the treatment of advanced glenohumeral osteoarthritis, and to identify associations between preoperative factors and outcomes.
Methods: Forty-nine shoulders (mean age 60 ± 7 years) with minimum 2-year follow-up (mean 4.
Purpose: Comminuted olecranon fractures are commonly fixed with posterior locking plates (PLPs). Though biomechanically validated, this method comes with risks of symptomatic implant prominence and wound breakdown. Dual locking plates (DLPs) placed on the medial and lateral surfaces of the olecranon theoretically avoid these risks and allow for fixation of proximal fracture fragments in multiple planes.
View Article and Find Full Text PDFIntroduction: A comprehensive understanding of the trends for financial reimbursement of shoulder arthroplasty is important as progress is made toward achieving sustainable payment models in orthopaedics. This study analyzes Medicare reimbursement trends for shoulder arthroplasty. We hypothesize that Medicare reimbursement has decreased for shoulder arthroplasty procedures from 2000 to 2020 and that revision procedures have experienced greater decreases in reimbursement.
View Article and Find Full Text PDFBackground: The American Shoulder and Elbow Surgeons multicenter taskforce studying proximal humerus fractures reached no consensus on which outcome measures to include in future studies, and currently no gold standard exists. Knowledge of commonly used outcome measures will allow standardization, enabling more consistent proximal humerus fracture treatment comparison. This study identifies the most commonly reported outcome measures for proximal humerus fracture management in recent literature.
View Article and Find Full Text PDFBackground: Health-related quality-of-life (HRQoL) scores are required for cost-effectiveness and health-care value analysis. We evaluated HRQoL scores and patient-reported outcome measures (PROMs) in patients with advanced glenohumeral osteoarthritis treated with anatomic total shoulder arthroplasty to establish values of HRQoL scores that can be used for cost-effectiveness and value analysis and to assess relationships between HRQoL scores and shoulder and upper-extremity PROMs.
Methods: We analyzed 143 patients (143 shoulders) with glenohumeral osteoarthritis treated with anatomic total shoulder arthroplasty; 92 patients had 1-year follow-up.
Background: A standard definition for massive rotator cuff tears (MRCTs) has not been identified. The purpose of this study is to use the modified Delphi technique to determine a practical, consensus definition for MRCTs.
Methods: This study is based on responses from 20 experts who participated in 4 rounds of surveys to determine a consensus definition for MRCT.
Background: Health-related quality-of-life (HRQoL) scores are required for cost-effectiveness and health-care value analysis. We evaluated HRQoL scores and patient-reported outcome measures (PROMs) in patients with advanced glenohumeral osteoarthritis treated with anatomic total shoulder arthroplasty to establish values of HRQoL scores that can be used for cost-effectiveness and value analysis and to assess relationships between HRQoL scores and shoulder and upper-extremity PROMs.
Methods: We analyzed 145 patients (145 shoulders) with glenohumeral osteoarthritis treated with anatomic total shoulder arthroplasty; 93 patients had 1-year follow-up.
Article Synopsis
- The study investigates two methods, asymmetric reaming (AR) and posteriorly augmented glenoid (PAG) components, to correct posterior glenoid wear and retroversion in shoulder arthroplasty patients.* -
- Results show that both approaches improve glenoid version, with PAG components generally providing greater correction but also posing a higher risk for central peg perforation, particularly with the 5 mm augmentation.* -
- Overall, both methods effectively re-center the humeral head, but further long-term studies are necessary to evaluate the clinical significance of these outcomes.*
Case: Two patients presented with infections of their recent proximal humerus fracture sites. These immunocompromised patients were being treated nonoperatively for their proximal humerus fractures; however, both were taken to the operating room for surgical debridement.
Conclusions: These 2 cases demonstrate the need for further investigation into infection of closed fracture sites.
Interprosthetic humeral shaft fractures involving shoulder and elbow arthroplasty can be difficult to manage surgically, both due to fracture and patient characteristics. Adequate fixation can be difficult, given the intramedullary nature of the adjacent implants. Careful attention must be paid to regional anatomy, and care must be taken to not damage the radial or ulnar nerve during dissection and mobilization of the fracture, especially if scar tissue exists from multiple previous surgeries.
View Article and Find Full Text PDFBackground: It is not always clear how to treat glenohumeral osteoarthritis, particularly in young patients. The goals of this study were to 1) quantify how patient age, activity level, symptoms, and radiographic findings impact the decision-making of shoulder specialists and 2) evaluate the observer reliability of the Kellgren-Lawrence (KL) grading system for primary osteoarthritis of the shoulder.
Methods: Twenty-six shoulder surgeons were each sent 54 simulated patient cases.